Approach to Metastatic Melanoma

2017 ◽  
Author(s):  
Alexandra Gangi ◽  
Jonathan S Zager
Keyword(s):  
Surgical Treatment ◽  
Metastatic Melanoma ◽  
Distant Metastasis ◽  
Systemic Therapy ◽  
Newly Diagnosed ◽  
Hepatic Perfusion ◽  
Melanoma Patients ◽  
Almost All ◽  
In Transit ◽  
Percutaneous Hepatic Perfusion

Over several decades, the incidence of melanoma has steadily risen. Although a minority of newly diagnosed melanoma patients present with distant metastasis at initial diagnosis, approximately 30% of patients eventually develop metastatic disease as a consequence of disease progression. Although almost all organs can be involved, the most frequent sites of disease are either local or regional recurrences. This review outlines surgical treatment of recurrent or metastatic melanoma, including regional therapies, as well as management with systemic therapy.  This review contains 5 figures, 6 tables and 66 references Key words: in-transit disease, limb infusion, metastatectomy, metastatic melanoma, percutaneous hepatic perfusion, regional therapy, systemic therapy

Approach to Metastatic Melanoma

2017 ◽  
Author(s):  
Alexandra Gangi ◽  
Jonathan S Zager
Keyword(s):  
Surgical Treatment ◽  
Metastatic Melanoma ◽  
Distant Metastasis ◽  
Systemic Therapy ◽  
Newly Diagnosed ◽  
Hepatic Perfusion ◽  
Melanoma Patients ◽  
Almost All ◽  
In Transit ◽  
Percutaneous Hepatic Perfusion

Over several decades, the incidence of melanoma has steadily risen. Although a minority of newly diagnosed melanoma patients present with distant metastasis at initial diagnosis, approximately 30% of patients eventually develop metastatic disease as a consequence of disease progression. Although almost all organs can be involved, the most frequent sites of disease are either local or regional recurrences. This review outlines surgical treatment of recurrent or metastatic melanoma, including regional therapies, as well as management with systemic therapy.  This review contains 5 figures, 6 tables and 66 references Key words: in-transit disease, limb infusion, metastatectomy, metastatic melanoma, percutaneous hepatic perfusion, regional therapy, systemic therapy

scholarly journals Chemosaturation with percutaneous hepatic perfusion for unresectable metastatic melanoma or sarcoma to the liver: A single institution experience

2013 ◽  
Vol 109 (5) ◽  
pp. 434-439 ◽  
Author(s):  
Meghan R. Forster ◽  
Omar M. Rashid ◽  
Matthew C. Perez ◽  
Junsung Choi ◽  
Tariq Chaudhry ◽  
...  
Keyword(s):  
Metastatic Melanoma ◽  
Single Institution ◽  
Hepatic Perfusion ◽  
Percutaneous Hepatic Perfusion

The current role of systemic therapy in the management of Malignant Melanoma of the skin: a literature review

2004 ◽  
Vol 4 (4) ◽  
pp. 161-175 ◽  
Author(s):  
Elizabeth Reeves ◽  
P. Bridge ◽  
R. M. Appleyard
Keyword(s):  
Clinical Trials ◽  
Literature Review ◽  
Metastatic Melanoma ◽  
Systemic Therapy ◽  
Survival Rates ◽  
Success Rates ◽  
Systemic Treatments ◽  
Melanoma Patients ◽  
Disease Free

Melanoma patients can be split into two main categories that have different aims for treatment; localised disease with either intermediate or high-risk of recurrence after surgery, and metastatic disease. Over the past decade, there have been many clinical trials looking at improving the success rates for localised and metastatic melanoma with alternative systemic treatments, namely immunotherapy, biochemotherapy and vaccines. This literature review summarises the clinical trials for each form of systemic treatment in localised and metastatic melanoma and assesses the effectiveness of each by an evaluation and comparison of relevant clinical trials for each systemic modality. The main objective was to assess whether alternative forms of systemic therapy have improved the disease free and overall survival rates achieved with chemotherapy.

scholarly journals Intracranial Treatment in Melanoma Patients with Brain Metastasis Is Associated with Improved Survival in the Era of Immunotherapy and Anti-BRAF Therapy

Cancers ◽  
2021 ◽  
Vol 13 (17) ◽  
pp. 4493
Author(s):  
Céline Dalmasso ◽  
Cécile Pagès ◽  
Léonor Chaltiel ◽  
Vincent Sibaud ◽  
Elisabeth Moyal ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Metastatic Melanoma ◽  
Systemic Treatment ◽  
Checkpoint Inhibitors ◽  
Locally Advanced ◽  
Treatment Patterns ◽  
Newly Diagnosed ◽  
Mutation Status ◽  
Multivariable Analyses ◽  
Melanoma Patients

Metastatic melanoma patients are at high risk of brain metastases (BM). Although intracranial control is a prognostic factor for survival, impact of local (intracranial) treatment (LT), surgery and/or radiotherapy (stereotactic or whole brain) in the era of novel therapies remains unknown. We evaluated BM incidence in melanoma patients receiving immune checkpoint inhibitors (ICI) or anti-BRAF therapy and identified prognostic factors for overall survival (OS). Clinical data and treatment patterns were retrospectively collected from all patients treated for newly diagnosed locally advanced or metastatic melanoma between May 2014 and December 2017 with available BRAF mutation status and receiving systemic therapy. Prognostic factors for OS were analyzed with univariable and multivariable survival analyses. BMs occurred in 106 of 250 eligible patients (42.4%), 64 of whom received LT. Median OS in patients with BM was 7.8 months (95% CI [5.4–10.4]). In multivariable analyses, LT was significantly correlated with improved OS (HR 0.21, p < 0.01). Median OS was 17.3 months (95% CI [8.3–22.3]) versus 3.6 months (95% CI [1.4–4.8]) in patients with or without LT. LT correlates with improved OS in melanoma patients with BM in the era of ICI and anti-BRAF therapy. The use of LT should be addressed at diagnosis of BM while introducing systemic treatment.

scholarly journals Efficacy of pembrolizumab for advanced/metastatic melanoma: a meta-analysis

Open Medicine ◽  
2020 ◽  
Vol 15 (1) ◽  
pp. 447-456
Author(s):  
Qi Zhang ◽  
Geng-wei Huo ◽  
Hong-zhen Zhang ◽  
Ying Song
Keyword(s):  
Metastatic Melanoma ◽  
Systemic Therapy ◽  
Meta Analysis ◽  
Objective Response ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Prior Therapy ◽  
Melanoma Patients ◽  
Prior Systemic Therapy ◽  
Meta Analyses

AbstractThis study evaluates the efficacy of pembrolizumab for the treatment of advanced/metastatic melanoma. The literature search was conducted in electronic databases for studies that evaluated the efficacy and safety of pembrolizumab either alone or in combination with other treatments advanced/metastatic melanoma patients. Random-effects meta-analyses were performed to achieve pooled effect sizes of response and survival rates. The overall objective response rate (ORR) was 34.2% [95% confidence interval (CI): 30.4, 38.0]. However, ORR differed with respect to the history of prior systemic therapy. ORR was lower in studies with over 50% patients with prior therapy (25.5% [22.4, 28.5]) than in studies with under 50% patients with prior therapy (40.1% [34.1, 46.1]). ORR was higher in pembrolizumab monotherapy (32.9% [28.1, 37.7]) than in pembrolizumab–ipilimumab combination (27.6% [24.0, 31.2]). Overall ORR was inversely associated with visceral metastasis and prior systemic therapy. With pembrolizumab treatment, either alone or in combination, the progression-free survival (PFS) was 5.73 months; 12-, 24-, and 60-month PFS rate were 44%, 27%, and 25%, respectively; and 12-, 24-, and 60-month overall survival rates were 65%, 50%, and 41%, respectively. The percentage of AEs that led to treatment discontinuation was 13%. Pembrolizumab monotherapy is a valuable option for the treatment of advanced/metastatic melanoma patients.

Natural history of metastatic melanoma patients with CNS metastases

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 8054-8054
Author(s):  
M. A. Davies ◽  
A. Y. Bedikian ◽  
S. McIntyre ◽  
T. Smith ◽  
K. Kim ◽  
...  
Keyword(s):  
Metastatic Melanoma ◽  
Systemic Therapy ◽  
Primary Melanoma ◽  
High Rate ◽  
Leptomeningeal Disease ◽  
History Of ◽  
Melanoma Patients ◽  
Worse Prognosis ◽  
Chiron Corporation ◽  
Median Interval

8054 Background: Melanoma has a high rate of CNS metastasis (mets). The objective of this study was to evaluate the characteristics and outcomes of melanoma patients (pts) who develop CNS mets. Methods: 333 pts with a diagnosis of CNS mets were identified from databases of 743 chemotherapy naïve metastatic melanoma (MM) pts enrolled on clinical trials between 1986 and 2004. Their clinical and pathological characteristics were reviewed. Results: The site of primary melanoma was head or neck (60/333; 18%), trunk/abdomen (144/333; 43%), limbs (66/333; 20%), ocular (2/333; 1%), or unknown (61/333; 18%). Median Breslow thickness (BT) = 2.2 mm; BT < 1 mm = 39/217 (18%); and BT < 2 mm = 95/217 (44%). Median Clark level (CL)= IV; CL I = 0/180 (0%); CL II = 14/180 (8%); CL III = 70/180 (39%); and CL IV = 96/180 (53%) . The median interval from diagnosis of primary melanoma to CNS mets = 29.6 (range 0.3–393) months (mos). Median survival (MS) from CNS diagnosis = 4.6 (range 0–120) mos. MS was highest for pts with brain mets (n=307; 4.8 mos) compared to pts with brain mets plus leptomeningeal disease (LMD) (14; 2.0 mos) or pts with LMD alone (11; 1.2 mos) (p=.0048 for pts with LMD vs. without). MS varied for pts with 1 (6.6 mos), 2 (4.2 mos), 3 (5.9 mos) or >3 (3.5 mos) brain lesions at diagnosis of CNS mets. Among pts diagnosed with CNS mets at or prior to systemic therapy, MS was longer for pts with CNS mets only (n=20; 14.3 mos) compared to pts with CNS mets concurrent with extracranial mets (63; 7 mos) (p=.003). Patients who developed CNS mets after starting chemotherapy for extracranial mets (n=250; 3.7 mos) had a shorter MS than those diagnosed at or before systemic therapy (83; 7.9 mos, p<.001). Among pts diagnosed after starting systemic therapy, CNS mets were detected ≤ 12 months from the start of chemotherapy in 30% of pts (MS = 3 mos), 12–24 mos in 37% of pts (MS = 4.6 mos), and > 36 mos in 32% of pts (MS = 11.1 mos, p=.044 vs. other groups). Conclusions: This study represents one of the largest cohorts of pts with melanoma CNS mets. The presence of LMD, or development of CNS mets after starting systemic therapy, is associated with a worse prognosis. Among pts diagnosed with CNS mets at or before starting systemic therapy, the presence of concurrent non-CNS mets also portends for a worse outcome. Supported in part by Carol Courtney Memorial fund and Chiron Corporation. No significant financial relationships to disclose.

scholarly journals The Ratio of GrzB+ − FoxP3+ over CD3+ T Cells as a Potential Predictor of Response to Nivolumab in Patients with Metastatic Melanoma

Cancers ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 2325
Author(s):  
Giosuè Scognamiglio ◽  
Mariaelena Capone ◽  
Francesco Sabbatino ◽  
Annabella Di Mauro ◽  
Monica Cantile ◽  
...  
Keyword(s):  
Metastatic Melanoma ◽  
Immune Checkpoint Blockade ◽  
Prognostic Role ◽  
Dynamic Modulation ◽  
Antitumor Immunotherapy ◽  
Physical Interactions ◽  
Melanoma Patients ◽  
Score Model ◽  
In Transit ◽  
Immune Score

The understanding of the molecular pathways involved in the dynamic modulation of the tumor microenvironment (TME) has led to the development of innovative treatments for advanced melanoma, including immune checkpoint blockade therapies. These approaches have revolutionized the treatment of melanoma, but are not effective in all patients, resulting in responder and non-responder populations. Physical interactions among immune cells, tumor cells and all the other components of the TME (i.e., cancer-associated fibroblasts, keratinocytes, adipocytes, extracellular matrix, etc.) are essential for effective antitumor immunotherapy, suggesting the need to define an immune score model which can help to predict an efficient immunotherapeutic response. In this study, we performed a multiplex immunostaining of CD3, FOXP3 and GRZB on both primary and unmatched in-transit metastatic melanoma lesions and defined a novel ratio between different lymphocyte subpopulations, demonstrating its potential prognostic role for cancer immunotherapy. The application of the suggested ratio can be useful for the stratification of melanoma patients that may or may not benefit from anti-PD-1 treatment.

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